Recommended Adult Immunization ScheduleUnited States - 2014

Note: These recommendations must be read with the footnotes that follow
containing number of doses, intervals between doses, and other important information.
Figure 1. Recommended adult immunization schedule, by vaccine and age group1
VACCINE

Influenza

19-21 years

AGE GROUP

22-26 years

27-49 years

50-59 years

Tetanus, diphtheria, pertussis (Td/Tdap)

2 doses

Human papillomavirus (HPV) Female 5,*

3 doses

Human papillomavirus (HPV) Male 5,*

3 doses
1 dose

Measles, mumps, rubella (MMR)

1 or 2 doses

7,*

Pneumococcal 13-valent conjugate (PCV13)

Pneumococcal polysaccharide (PPSV23)
Meningococcal
Hepatitis A

65 years

Substitute 1-time dose of Tdap for Td booster; then boost with Td every 10 yrs

3,*

Varicella 4,*

Zoster

60-64 years

1 dose annually

2,*

8,*

1 dose
1 or 2 doses

9,10

1 dose

1 or more doses

11,*

12,*

2 doses

Hepatitis B 13,*

3 doses

Haemophilus influenzae type b (Hib) 14,*

1 or 3 doses

*Covered by the Vaccine Injury Compensation Program

For all persons in this category who
meet the age requirements and who
lack documentation of vaccination or
have no evidence of previous infection;
zoster vaccine recommended regardless
of prior episode of zoster
Recommended if some other risk
factor is present (e.g., on the basis of
medical, occupational, lifestyle, or other
indication)
No recommendation

Report all clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System (VAERS). Reporting forms and instructions on filing
a VAERS report are available at www.vaers.hhs.gov or by telephone, 800-822-7967.
Information on how to file a Vaccine Injury Compensation Program claim is available at www.hrsa.gov/vaccinecompensation or by telephone, 800-338-2382.
To file a claim for vaccine injury, contact the U.S. Court of Federal Claims, 717 Madison Place, N.W., Washington, D.C. 20005; telephone, 202-357-6400.
Additional information about the vaccines in this schedule, extent of available data, and contraindications for vaccination is also available at
www.cdc.gov/vaccines or from the CDC-INFO Contact Center at 800-CDC-INFO (800-232-4636) in English and Spanish, 8:00 a.m. - 8:00 p.m. Eastern
Time, Monday - Friday, excluding holidays.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
The recommendations in this schedule were approved by the Centers for Disease Control and Preventions (CDC) Advisory Committee on Immunization
Practices (ACIP), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), American College of Obstetricians and
Gynecologists (ACOG) and American College of Nurse-Midwives (ACNM).

Figure 2. Vaccines that might be indicated for adults based on medical and other indications1

VACCINE

HIV infection
Heart
Asplenia (including
Immunodisease,
elective splenectomy
compromising CD4+ T lymphocyte
4,6,7,8,15
count
Men who Kidney failure,
chronic
and persistent
conditions
have sex end-stage renal lung disease,
complement
Chronic
(excluding human
with men disease, receipt
chronic
component
liver
Healthcare
immunodeficiency < 200 200
(MSM) of hemodialysis alcoholism
deficiencies) 8,14
disease Diabetes personnel
INDICATION Pregnancy virus [HIV])4,6,7,8,15 cells/L cells/L

1 dose IIV annually

Influenza 2,*
Tetanus, diphtheria, pertussis (Td/Tdap) 3,*

1 dose Tdap each

pregnancy

1 dose IIV or
LAIV annually

Substitute 1-time dose of Tdap for Td booster; then boost with Td every 10 yrs

Contraindicated

Varicella 4,*

2 doses

3 doses through age 26 yrs

Human papillomavirus (HPV) Female 5,*

3 doses through age 26 yrs

3 doses through age 26 yrs

Human papillomavirus (HPV) Male 5,*

3 doses through age 21 yrs

Contraindicated

Zoster 6

1 dose

Contraindicated

Measles, mumps, rubella (MMR) 7,*

Pneumococcal 13-valent conjugate (PCV13)

1 or 2 doses
1 dose

8,*

1 or 2 doses

Pneumococcal polysaccharide (PPSV23) 9,10

1 or more doses

Meningococcal 11,*
Hepatitis A 12,*

2 doses

Hepatitis B 13,*

3 doses

Haemophilus influenzae type b (Hib) 14,*

*Covered by the Vaccine
Injury Compensation Program

1 dose IIV or LAIV

annually

1 dose IIV annually

post-HSCT recipients only

For all persons in this category who meet the age requirements and who
lack documentation of vaccination or have no evidence of previous infection;
zoster vaccine recommended regardless of prior episode of zoster

1 or 3 doses
Recommended if some other risk factor
is present (e.g., on the basis of medical,
occupational, lifestyle, or other indications)

No recommendation

These schedules indicate the recommended age groups and medical indications for which administration of currently licensed vaccines is commonly
indicated for adults ages 19 years and older, as of February 1, 2014. For all vaccines being recommended on the Adult Immunization Schedule:
a vaccine series does not need to be restarted, regardless of the time that has elapsed between doses. Licensed combination vaccines may be
used whenever any components of the combination are indicated and when the vaccines other components are not contraindicated. For detailed
recommendations on all vaccines, including those used primarily for travelers or that are issued during the year, consult the manufacturers package
inserts and the complete statements from the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/hcp/acip-recs/index.html). Use of
trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

Footnotes
Recommended Immunization Schedule for Adults Aged 19 Years or Older: United States, 2014
1. Additional information
Additional guidance for the use of the vaccines described in this supplement
is available at www.cdc.gov/vaccines/hcp/acip-recs/index.html.
Information on vaccination recommendations when vaccination status is
unknown and other general immunization information can be found in
the General Recommendations on Immunization at
www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm.
Information on travel vaccine requirements and recommendations (e.g.,
for hepatitis A and B, meningococcal, and other vaccines) is available at
http://wwwnc.cdc.gov/travel/destinations/list.
Additional information and resources regarding vaccination of pregnant women
can be found at http://www.cdc.gov/vaccines/adults/rec-vac/pregnant.html.
2. Influenza vaccination
Annual vaccination against influenza is recommended for all persons
aged 6 months or older.
Persons aged 6 months or older, including pregnant women and persons
with hives-only allergy to eggs, can receive the inactivated influenza
vaccine (IIV). An age-appropriate IIV formulation should be used.
Adults aged 18 to 49 years can receive the recombinant influenza vaccine
(RIV) (FluBlok). RIV does not contain any egg protein.
Healthy, nonpregnant persons aged 2 to 49 years without high-risk medical
conditions can receive either intranasally administered live, attenuated
influenza vaccine (LAIV) (FluMist), or IIV. Health care personnel who care
for severely immunocompromised persons (i.e., those who require care in
a protected environment) should receive IIV or RIV rather than LAIV.
The intramuscularly or intradermally administered IIV are options for
adults aged 18 to 64 years.
Adults aged 65 years or older can receive the standard-dose IIV or the
high-dose IIV (Fluzone High-Dose).
3. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination
Administer 1 dose of Tdap vaccine to pregnant women during each
pregnancy (preferred during 27 to 36 weeks gestation) regardless of
interval since prior Td or Tdap vaccination.
Persons aged 11 years or older who have not received Tdap vaccine
or for whom vaccine status is unknown should receive a dose of Tdap
followed by tetanus and diphtheria toxoids (Td) booster doses every 10
years thereafter. Tdap can be administered regardless of interval since
the most recent tetanus or diphtheria-toxoid containing vaccine.
Adults with an unknown or incomplete history of completing a 3-dose
primary vaccination series with Td-containing vaccines should begin or
complete a primary vaccination series including a Tdap dose.
For unvaccinated adults, administer the first 2 doses at least 4 weeks apart
and the third dose 6 to 12 months after the second.
For incompletely vaccinated (i.e., less than 3 doses) adults, administer
remaining doses.
Refer to the ACIP statement for recommendations for administering Td/
Tdap as prophylaxis in wound management (see footnote 1).
4. Varicella vaccination
All adults without evidence of immunity to varicella (as defined below)
should receive 2 doses of single-antigen varicella vaccine or a second
dose if they have received only 1 dose.
Vaccination should be emphasized for those who have close contact
with persons at high risk for severe disease (e.g., health care personnel
and family contacts of persons with immunocompromising conditions)
or are at high risk for exposure or transmission (e.g., teachers; child
care employees; residents and staff members of institutional settings,
including correctional institutions; college students; military personnel;
adolescents and adults living in households with children; nonpregnant
women of childbearing age; and international travelers).
Pregnant women should be assessed for evidence of varicella immunity.
Women who do not have evidence of immunity should receive the first
dose of varicella vaccine upon completion or termination of pregnancy
and before discharge from the health care facility. The second dose should
be administered 4 to 8 weeks after the first dose.
Evidence of immunity to varicella in adults includes any of the following:
documentation of 2 doses of varicella vaccine at least 4 weeks apart;
U.S.-born

before 1980, except health care personnel and pregnant women;

history of varicella based on diagnosis or verification of varicella disease
by a health care provider;
history of herpes zoster based on diagnosis or verification of herpes
zoster disease by a health care provider; or
laboratory evidence of immunity or laboratory confirmation of disease.
5. Human papillomavirus (HPV) vaccination
Two vaccines are licensed for use in females, bivalent HPV vaccine (HPV2)
and quadrivalent HPV vaccine (HPV4), and one HPV vaccine for use in
males (HPV4).
For females, either HPV4 or HPV2 is recommended in a 3-dose series for
routine vaccination at age 11 or 12 years and for those aged 13 through
26 years, if not previously vaccinated.
For males, HPV4 is recommended in a 3-dose series for routine vaccination
at age 11 or 12 years and for those aged 13 through 21 years, if not
previously vaccinated. Males aged 22 through 26 years may be vaccinated.

5. Human papillomavirus (HPV) vaccination (contd)

HPV4 is recommended for men who have sex with men through age 26
years for those who did not get any or all doses when they were younger.
Vaccination is recommended for immunocompromised persons
(including those with HIV infection) through age 26 years for those who
did not get any or all doses when they were younger.
A complete series for either HPV4 or HPV2 consists of 3 doses. The second
dose should be administered 4 to 8 weeks (minimum interval of 4 weeks)
after the first dose; the third dose should be administered 24 weeks after
the first dose and 16 weeks after the second dose (minimum interval of
at least 12 weeks).
HPV vaccines are not recommended for use in pregnant women. However,
pregnancy testing is not needed before vaccination. If a woman is found
to be pregnant after initiating the vaccination series, no intervention
is needed; the remainder of the 3-dose series should be delayed until
completion of pregnancy.
6. Zoster vaccination
A single dose of zoster vaccine is recommended for adults aged 60 years
or older regardless of whether they report a prior episode of herpes zoster.
Although the vaccine is licensed by the U.S. Food and Drug Administration
for use among and can be administered to persons aged 50 years or older,
ACIP recommends that vaccination begin at age 60 years.
Persons aged 60 years or older with chronic medical conditions may be
vaccinated unless their condition constitutes a contraindication, such as
pregnancy or severe immunodeficiency.
7. Measles, mumps, rubella (MMR) vaccination
Adults born before 1957 are generally considered immune to measles and
mumps. All adults born in 1957 or later should have documentation of 1 or
more doses of MMR vaccine unless they have a medical contraindication
to the vaccine or laboratory evidence of immunity to each of the three
diseases. Documentation of provider-diagnosed disease is not considered
acceptable evidence of immunity for measles, mumps, or rubella.
Measles component:
A routine second dose of MMR vaccine, administered a minimum of 28
days after the first dose, is recommended for adults who:
are students in postsecondary educational institutions;
work in a health care facility; or
plan to travel internationally.
Persons who received inactivated (killed) measles vaccine or measles
vaccine of unknown type during 19631967 should be revaccinated with
2 doses of MMR vaccine.
Mumps component:
A routine second dose of MMR vaccine, administered a minimum of 28
days after the first dose, is recommended for adults who:
are students in a postsecondary educational institution;
work in a health care facility; or
plan to travel internationally.
Persons vaccinated before 1979 with either killed mumps vaccine
or mumps vaccine of unknown type who are at high risk for mumps
infection (e.g., persons who are working in a health care facility) should
be considered for revaccination with 2 doses of MMR vaccine.
Rubella component:
For women of childbearing age, regardless of birth year, rubella immunity
should be determined. If there is no evidence of immunity, women who
are not pregnant should be vaccinated. Pregnant women who do not have
evidence of immunity should receive MMR vaccine upon completion or
termination of pregnancy and before discharge from the health care facility.
Health care personnel born before 1957:
For unvaccinated health care personnel born before 1957 who lack
laboratory evidence of measles, mumps, and/or rubella immunity or
laboratory confirmation of disease, health care facilities should consider
vaccinating personnel with 2 doses of MMR vaccine at the appropriate
interval for measles and mumps or 1 dose of MMR vaccine for rubella.
8. Pneumococcal conjugate (PCV13) vaccination
Adults aged 19 years or older with immunocompromising conditions
(including chronic renal failure and nephrotic syndrome), functional or
anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants who
have not previously received PCV13 or PPSV23 should receive a single
dose of PCV13 followed by a dose of PPSV23 at least 8 weeks later.
Adults aged 19 years or older with the aforementioned conditions who
have previously received 1 or more doses of PPSV23 should receive a dose
of PCV13 one or more years after the last PPSV23 dose was received. For
adults who require additional doses of PPSV23, the first such dose should
be given no sooner than 8 weeks after PCV13 and at least 5 years after
the most recent dose of PPSV23.
When indicated, PCV13 should be administered to patients who are
uncertain of their vaccination status history and have no record of previous vaccination.
Although PCV13 is licensed by the U.S. Food and Drug Administration
for use among and can be administered to persons aged 50 years or
older, ACIP recommends PCV13 for adults aged 19 years or older with
the specific medical conditions noted above.

9. Pneumococcal polysaccharide (PPSV23) vaccination

When PCV13 is also indicated, PCV13 should be given first (see footnote 8).
Vaccinate all persons with the following indications:
all adults aged 65 years or older;
adults younger than 65 years with chronic lung disease (including
chronic obstructive pulmonary disease, emphysema, and asthma),
chronic cardiovascular diseases, diabetes mellitus, chronic renal failure, nephrotic syndrome, chronic liver disease (including cirrhosis),
alcoholism, cochlear implants, cerebrospinal fluid leaks, immunocompromising conditions, and functional or anatomic asplenia (e.g., sickle
cell disease and other hemoglobinopathies, congenital or acquired
asplenia, splenic dysfunction, or splenectomy [if elective splenectomy
is planned, vaccinate at least 2 weeks before surgery]);
residents of nursing homes or long-term care facilities; and
adults who smoke cigarettes.
Persons with immunocompromising conditions and other selected
conditions are recommended to receive PCV13 and PPSV23 vaccines. See
footnote 8 for information on timing of PCV13 and PPSV23 vaccinations.
Persons with asymptomatic or symptomatic HIV infection should be
vaccinated as soon as possible after their diagnosis.
When cancer chemotherapy or other immunosuppressive therapy is
being considered, the interval between vaccination and initiation of
immunosuppressive therapy should be at least 2 weeks. Vaccination
during chemotherapy or radiation therapy should be avoided.
Routine use of PPSV23 vaccine is not recommended for American Indians/
Alaska Natives or other persons younger than 65 years unless they have
underlying medical conditions that are PPSV23 indications. However, public health authorities may consider recommending PPSV23 for American
Indians/Alaska Natives who are living in areas where the risk for invasive
pneumococcal disease is increased.
When indicated, PPSV23 vaccine should be administered to patients who
are uncertain of their vaccination status and have no record of vaccination.
10. Revaccination with PPSV23
One-time revaccination 5 years after the first dose of PPSV23 is recommended for persons aged 19 through 64 years with chronic renal failure
or nephrotic syndrome, functional or anatomic asplenia (e.g., sickle cell
disease or splenectomy), or immunocompromising conditions.
Persons who received 1 or 2 doses of PPSV23 before age 65 years for any
indication should receive another dose of the vaccine at age 65 years or
later if at least 5 years have passed since their previous dose.
No further doses of PPSV23 are needed for persons vaccinated with
PPSV23 at or after age 65 years.
11. Meningococcal vaccination
Administer 2 doses of quadrivalent meningococcal conjugate vaccine
(MenACWY [Menactra, Menveo]) at least 2 months apart to adults of all
ages with functional asplenia or persistent complement component
deficiencies. HIV infection is not an indication for routine vaccination with
MenACWY. If an HIV-infected person of any age is vaccinated, 2 doses of
MenACWY should be administered at least 2 months apart.
Administer a single dose of meningococcal vaccine to microbiologists
routinely exposed to isolates of Neisseria meningitidis, military recruits,
persons at risk during an outbreak attributable to a vaccine serogroup,
and persons who travel to or live in countries in which meningococcal
disease is hyperendemic or epidemic.
First-year college students up through age 21 years who are living in
residence halls should be vaccinated if they have not received a dose on
or after their 16th birthday.
MenACWY is preferred for adults with any of the preceding indications
who are aged 55 years or younger as well as for adults aged 56 years or
older who a) were vaccinated previously with MenACWY and are recommended for revaccination, or b) for whom multiple doses are anticipated.
Meningococcal polysaccharide vaccine (MPSV4 [Menomune]) is preferred
for adults aged 56 years or older who have not received MenACWY previously and who require a single dose only (e.g., travelers).
Revaccination with MenACWY every 5 years is recommended for adults
previously vaccinated with MenACWY or MPSV4 who remain at increased
risk for infection (e.g., adults with anatomic or functional asplenia, persistent complement component deficiencies, or microbiologists).
12. Hepatitis A vaccination
Vaccinate any person seeking protection from hepatitis A virus (HAV)
infection and persons with any of the following indications:
men who have sex with men and persons who use injection or noninjection illicit drugs;
persons working with HAV-infected primates or with HAV in a research
laboratory setting;
persons with chronic liver disease and persons who receive clotting
factor concentrates;
persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A; and

12. Hepatitis A vaccination (contd)

unvaccinated persons who anticipate close personal contact (e.g.,
household or regular babysitting) with an international adoptee
during the first 60 days after arrival in the United States from a country with high or intermediate endemicity. (See footnote 1 for more
information on travel recommendations.) The first dose of the 2-dose
hepatitis A vaccine series should be administered as soon as adoption
is planned, ideally 2 or more weeks before the arrival of the adoptee.
Single-antigen vaccine formulations should be administered in a 2-dose
schedule at either 0 and 6 to 12 months (Havrix), or 0 and 6 to 18 months
(Vaqta). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is
used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose
schedule may be used, administered on days 0, 7, and 21 to 30 followed
by a booster dose at month 12.
13. Hepatitis B vaccination
Vaccinate persons with any of the following indications and any person
seeking protection from hepatitis B virus (HBV) infection:
sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than 1 sex partner during
the previous 6 months); persons seeking evaluation or treatment for
a sexually transmitted disease (STD); current or recent injection drug
users; and men who have sex with men;
health care personnel and public safety workers who are potentially
exposed to blood or other infectious body fluids;
persons with diabetes who are younger than age 60 years as soon as
feasible after diagnosis; persons with diabetes who are age 60 years or
older at the discretion of the treating clinician based on the likelihood
of acquiring HBV infection, including the risk posed by an increased
need for assisted blood glucose monitoring in long-term care facilities, the likelihood of experiencing chronic sequelae if infected with
HBV, and the likelihood of immune response to vaccination;
persons with end-stage renal disease, including patients receiving
hemodialysis, persons with HIV infection, and persons with chronic
liver disease;
household contacts and sex partners of hepatitis B surface antigenpositive persons, clients and staff members of institutions for
persons with developmental disabilities, and international travelers
to countries with high or intermediate prevalence of chronic HBV
infection; and
all adults in the following settings: STD treatment facilities, HIV testing and treatment facilities, facilities providing drug abuse treatment
and prevention services, health care settings targeting services to
injection drug users or men who have sex with men, correctional
facilities, end-stage renal disease programs and facilities for chronic
hemodialysis patients, and institutions and nonresidential day care
facilities for persons with developmental disabilities.
Administer missing doses to complete a 3-dose series of hepatitis B
vaccine to those persons not vaccinated or not completely vaccinated.
The second dose should be administered 1 month after the first dose; the
third dose should be given at least 2 months after the second dose (and
at least 4 months after the first dose). If the combined hepatitis A and
hepatitis B vaccine (Twinrix) is used, give 3 doses at 0, 1, and 6 months;
alternatively, a 4-dose Twinrix schedule, administered on days 0, 7, and
21 to 30 followed by a booster dose at month 12 may be used.
Adult patients receiving hemodialysis or with other immunocompromising
conditions should receive 1 dose of 40 mcg/mL (Recombivax HB)
administered on a 3-dose schedule at 0, 1, and 6 months or 2 doses of 20
mcg/mL (Engerix-B) administered simultaneously on a 4-dose schedule
at 0, 1, 2, and 6 months.
14. Haemophilus influenzae type b (Hib) vaccination
One dose of Hib vaccine should be administered to persons who have
functional or anatomic asplenia or sickle cell disease or are undergoing
elective splenectomy if they have not previously received Hib vaccine.
Hib vaccination 14 or more days before splenectomy is suggested.
Recipients of a hematopoietic stem cell transplant should be vaccinated
with a 3-dose regimen 6 to 12 months after a successful transplant,
regardless of vaccination history; at least 4 weeks should separate doses.
Hib vaccine is not recommended for adults with HIV infection since their
risk for Hib infection is low.
15. Immunocompromising conditions
Inactivated vaccines generally are acceptable (e.g., pneumococcal,
meningococcal, and inactivated influenza vaccine) and live vaccines
generally are avoided in persons with immune deficiencies or
immunocompromising conditions. Information on specific conditions
is available at http://www.cdc.gov/vaccines/hcp/acip-recs/index.html.